两种骨水泥应用于老年胸腰椎骨折椎体成形术的疗效观察

[目的]探讨两种骨水泥应用于老年胸腰椎骨质疏松性骨折椎体成形术的疗效。[方法]2012年1月~2012年12月本科采用椎体成形术治疗老年胸腰椎骨质疏松性骨折59例,分为A、B两组。A组为PMMA组,B组为Confidence高粘度骨水泥组。采用视觉模拟疼痛评分、ODI评分进行疼痛疗效评价,测量对照术前、术后椎体前缘高度和Cobb角,所有结果采用配对t检验进行统计分析。[结果]患者术后24 h内疼痛症状均明显缓解,A、B两组患者手术后伤椎前缘高度、Cobb角、VAS评分、ODI评分与术前相比均有改善(P0.05),手术前后差值组间相比无统计学意义(P0.05)。[结论]Confidence高粘度骨水泥用于骨质疏松性胸腰椎骨折,可以获得与PMMA相近的临床疗效。     

椎体成形联合体位复位治疗椎体压缩性骨折

[目的]探索经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)联合体位复位法治疗老年人椎体压缩性骨折(vertebral compression fractures,VCFs)的疗效。[方法]分析2014~2015年间74例老年性椎体压缩性骨折患者的资料,其中行单纯PVP治疗者35例,行PVP联合体位复位者39例。比较两组疼痛和生活功能改善情况(VAS评分、ODI评分)。测量伤椎椎体前缘高度及矢状面Cobb角,探究两种治疗方案对于后凸畸形的矫正能力。并观察骨水泥漏、再骨折等相关手术并发症的发生率。[结果]两种治疗方案均能较好的改善疼痛症状,并恢复良好的日常生活功能。术前、术后、术后1年两者在VAS、ODI评分上均无统计学差异(P>0.05)。无论术后还是术后1年,PVP联合体位复位在恢复椎体前缘高度及矢状面Cobb角均较单纯PVP组有着明显的优势(P<0.05)。骨水泥漏发生率在两种治疗方案中无明显统计学差异(P>0.05)。术后再骨折及临近节段椎体骨折发生率两者均无明显统计学差异(P>0.05)。[结论]两种治疗方案均能较好的治疗胸腰椎骨折,缓解症状,恢复日常生活功能。PVP联合体位复位能更好的恢复椎体前缘高度,纠正后凸畸形。在骨水泥漏、再骨折等并发症中,两种治疗方案无明显差异。     

经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效观察

[目的]比较经皮椎体成形术和经皮椎体后凸成形术在治疗老年骨质疏松椎体压缩性骨折方面的疗效。[方法]选择2011年1月~2013年12月来本院就治的72例老年骨质疏松椎体压缩性骨折患者,分为2组,PVP组40例,PKP组32例。观察两组手术前后VAS评分、椎体压缩率、伤椎Cobb角、骨水泥注入量、术后伤椎增加高度、骨水泥渗漏情况。[结果]两组手术前后,其VAS评分均显著下降,患者疼痛缓解明显,但两组组间差异无统计学意义;PKP组椎体压缩率和Cobb角与术前比较显著降低,但PVP组治疗前后差异无统计学意义,PKP组治疗后的椎体压缩率和Cobb角要低于PVP组,差异有统计学意义;与PVP组比较,PKP组手术时间较长,骨水泥注入量较多,术后伤椎高度增加较大,骨水泥渗漏情况较少,差异均有统计学意义。[结果]PVP、PKP两种手术方法均具有显著止痛效果,PKP较PVP椎体高度恢复及脊柱后凸畸形矫正效果更好。     

Confidence高黏度骨水泥椎体成形术联合过伸体位复位在骨质疏松性椎体压缩骨折的临床应用

目的对骨质疏松性椎体压缩性骨折(Osteoporotic vertebral compression fractures,OVCF)患者,尝试在理想的过伸体位复位基础上给予Confidence高黏度骨水泥经皮椎体成形术(Percutaneous Vertebroplasty,PVP)治疗,探讨其相对于传统PVP手术的优势。方法自2013-05-2015-10,随机选择60例OVCF患者,单椎体骨折53例,双椎体7例。采用随机数字表法,分为观察组和对照组各30例。对照组给予传统的PVP手术(选用普通的PMMA骨水泥),观察组患者在伤后3d开始过伸体位复位,7-14 d复位满意后给予Confidence高黏度骨水泥PVP手术。结果(1)两组的手术时间、术中出血量和骨水泥注射量对比,无显著性差异(P0.05);(2)两组术后,VAS和ODI评分均较术前有显著改善(P0.05);组间比较,均无显著性差异(P0.05);(3)两组术后,观察组患者的Cobb角和伤椎前缘、中线高度压缩率均有显著性改善(P0.05),且均显著优于对照组(P0.05);(4)术后共有14例出现骨水泥渗漏,其中7个渗漏至椎旁软组织,5个渗漏至椎间隙,2个伴有轻度的脊髓和神经根压迫,对症处理后得到明显改善。其中,观察组骨水泥渗漏率为11.8%,显著低于对照组的30.3%(P0.05)。结论在术前过伸体位复位达到预期效果的基础上行Confidence高黏度骨水泥PVP手术治疗OVCF患者,能显著缓解疼痛症状,有较好的矫正作用,能显著降低骨水泥渗漏的发生率。     

经皮椎体后凸成形术与经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效比较

[目的]探讨经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松椎体压缩骨折(OVCF)的效果。[方法]选取2014年12月~2015年12月在本院诊治的86例骨质疏松性椎体压缩性骨折患者的临床资料,采用随机数字表法分为经皮椎体成形术组(PVP),和经皮椎体后凸成形术组(PKP)各43例。观察两组围手术期资料、伤椎Cobb角、手术前后VAS评分、术后伤椎恢复情况及并发症情况。[结果]PKP组手术时间、骨水泥注入量、术后伤椎高度增加都明显高于PVP组(P<0.05);治疗后两组椎体压缩率、伤椎Cobb角显著降低,且PKP组术后椎体压缩率、伤椎Cobb角显著低于PVP组(P<0.05)。术后两组患者VAS评分显著降低,但两组间比较无明显差异(P>0.05)。[结论]经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松椎体压缩骨折效果满意,经皮椎体后凸成形术在改善患者椎体高度、伤椎畸形优势明显。     

过伸性体位复位结合PVP与PKP治疗骨质疏松性椎体压缩性骨折

目的比较过伸性体位复位结合经皮椎体成形术(PVP)和经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法将81例老年OVCF患者(112椎体)根据治疗方法分为过伸性体位复位结合PVP组和PKP组。比较两组手术时间、透视次数、住院天数、治疗费用、手术前后VAS评分和ODI及椎体高度恢复情况。结果患者均获得随访,时间8~24个月。两组手术时间、透视次数、治疗费用、住院天数相比,过伸性体位复位结合PVP组均少于PKP组,差异有统计学意义(P0.05)。两组术后VAS评分、ODI及椎体高度均较术前有明显改善(P0.05);两组间比较差异无统计学意义(P0.05)。结论过伸性体位复位结合PVP与PKP治疗骨质疏松性压缩性骨折疗效相当,但过伸性体位复位结合PVP较PKP手术时间更短、费用更少。     

单侧与双侧入路椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床研究

目的：探讨经单侧与双侧穿刺椎体后凸成形术治疗骨质疏松性椎体压缩性骨折临床疗效。方法选取我院2007-01-2010-12收治的骨质疏松性椎体压缩性骨折患者80例,随机分为单侧穿刺组与双侧穿刺组,观察两组手术时间、X线机曝光次数、出血量、骨水泥量、手术前后VAS评分变化、椎体平均高度、局部Cobb角改善、骨水泥渗漏及椎体再骨折发生情况。结果单侧组在平均手术时间、平均骨水泥注入量、平均出血量及X线曝光次数上均较双侧组少。两组术后及末次随访时VAS评分均较术前明显降低,术后两组椎体平均高度及局部Cobb角较术前均有显著恢复,组间比较无显著性差异;两组在骨水泥渗漏及邻近椎体再骨折的发生率比较无显著性差异。结论经单侧椎弓根途径穿刺骨水泥过椎体中线注射治疗骨质疏松性椎体压缩骨折可取得双侧穿刺同样满意的临床效果。     

高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的效果

目的探讨高黏度骨水泥经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的效果。方法随机将80例接受椎体成形手术的骨质疏松性椎体压缩性骨折患者分为2组,各40例。观察组应用高黏度骨水泥,对照组应用普通骨水泥。比较2组术后第1天、1个月及6个月的椎体前缘高度、Cobb角和疼痛评分(VAS)、脊柱评分(ODI);统计2组骨水泥渗透率。结果 (1)治疗前2组的椎体前缘高度、Cobb角和VAS评分、ODI脊柱评分差异无统计学意义(P0.05)。2组术后第1天、1个月及6个月的椎体前缘高度、Cobb角、ODI脊柱评分均优于术前,差异有统计学意义(P0.05);但组间差异无统计学意义(P0.05)。(2)术后第1天观察组的VAS评分优于对照组,差异有统计学意义(P0.05);但术后1个月及6个月2组的VAS评分差异无统计学意义(P0.05)。(3)观察组骨水泥渗透率低于对照组,差异有统计学意义(P0.05)。随访期间2组邻近椎体压缩性骨折等并发症发生率比较,差异无统计学意义(P0.05)。结论高黏度骨水泥和普通水泥应用于椎体成形术治疗骨质疏松性椎体压缩性骨折,均有可靠效果,但前者能快速缓解患者的疼痛程度,且骨水泥渗漏率较低。     

单侧与双侧入路经皮椎体成形术治疗骨质疏松压缩性骨折的比较研究

[目的]比较单侧与双侧椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效.[方法]2007年9月～2011年7月,46例骨质疏松胸腰椎单节椎体压缩性骨折患者被随机分为两组,其中单侧组22例,双侧组24例.对两组患者的临床资料进行前瞻性分析,比较两组患者的临床疗效.[结果]所有患者均获得1年以上随访,两组患者术前临床资料差异无统计学意义(P＞0.05).两组术后椎体高度及后凸Cobb角均较术前改善(P＜0.01),而两组椎体高度恢复率、椎体后凸Cobb角恢复率差异无统计学意义(P＞0.05).两组患者术后24 h、术后1周、术后1年时,VAS、ODI评分较术前均有改善(P＜0.01),而两组间差异均无统计学意义(P＞0.05).手术时间、X线暴露时间、骨水泥灌注量及骨水泥渗漏发生率,单侧组少于双侧组,两组差异有统计学意义(P＜0.01),但两组间邻近椎体骨折发生率差异无统计学意义(P＞0.05).[结论]单侧与双侧椎弓根入路经皮椎体成形术治疗骨质疏松椎体压缩性骨折均能获得良好的临床疗效,但单侧椎弓根入路具有手术时间短、X线暴露时间短、骨水泥渗漏发生率低的优点.     

止痛泵下手法复位联合经皮椎体成形术治疗老年骨质疏松性压缩骨折

目的 探讨止痛泵下手法复位联合经皮椎体成形术（PVP)治疗老年骨质疏松性压缩骨折的临 床效果及并发症。方法 自2008年8月至2011年9月，74例骨质疏松性压缩骨折患者在C型臂下行手法复位后马上行经皮椎体成形术，整个操作过程患者带自控镇痛泵。所有患者均在术后行X线检查以评价骨水泥填充情况及有无渗漏。疗效判定采用视觉模拟评分（visual analogue scale, VAS )， 对患者术前、术后疼痛情况进行分级比较，观察手术并发症，以及Cobb角、椎体前缘高度改善情况。 结果 手术成功率高，术后患者疼痛明显减轻或消失，17例出现骨水泥的渗漏，有6例出现穿刺部位疼痛，X线检查骨水泥充填良好，骨折复位满意，术后Cobb角及椎体前缘高度均显著改善。74例患 者平均随访19个月，疼痛未见加重，仅2个椎体高度出现少量丢失，2例患者邻近椎体发生骨折，再 次行经皮椎体成形术。结论 止痛泵下手法复位联合PVP治疗骨质疏松性压缩性骨折疗效好，整个治疗过程痛苦小，可在短时间内解除患者痛苦。     

经后路椎间盘镜椎间盘切除术

本院于２０００年３月至２００１年１１月，采用经后路椎间盘镜施行腰椎间盘手术（MED组）６６例，与１９９８年１月至２０００年４月采用传统开放手术（传统组）５８例进行了比较观察，MED组恢复良好。报告如下。１资料与方法１．１一般资料：MED组中男４４例，女２２例，年龄３０～６５岁，平均４８岁；病程１个月～６年，平均２年５个月；其中多间隙突出８例，巨大中央型突出５例，突出髓核伴钙化１１例，明显小关节内聚伴侧隐窝狭窄１０例，腰椎间盘侧后方突出或或脱出２９例，伴黄韧带肥厚３例，其中６例合并以上两种病变。传统组…     

相隔单椎体跳跃性椎体结核的手术治疗

目的探讨前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核的临床疗效。方法2002年3月至2005年3月,对21例相隔一个正常椎体的跳跃性胸腰椎椎体结核患者施行前路病灶清除植骨融合椎体钉棒内固定治疗,植骨采用自体髂骨-肋骨或钛网-肋骨植骨。男14例,女7例;年龄22～67岁,平均43岁。病变范围：T4～L3,胸椎12例,胸腰段6例,腰椎3例。两处跳跃病变破坏2个椎体1例、3个椎体7例、4个椎体10例;三处跳跃病变破坏5个椎体2例,6个椎体1例。病变节段后凸角：胸椎30°～50°,胸腰段15°～30°,腰椎10°～20°。4例伴不完全截瘫。术前强化抗痨2～4周,术后规则抗痨1年。结果21例患者随访2.1～5.1年,平均3.4年。切口均一期愈合,术后早期肺不张2例,腹胀1例,经保守治疗1周内恢复。术后1～3个月红细胞沉降率、C-反应蛋白逐渐恢复正常。手术矫正后凸畸形10°～30°,末次随访畸形矫正角度丢失≤5.1°。植骨于术后3个月开始出现融合,随访期间无植骨块移位和内固定松动、折断。4例不完全截瘫患者术后6个月神经功能基本恢复正常。结论前路病灶清除植骨融合内固定治疗相隔单椎体跳跃性椎体结核可彻底清除病灶、矫正后凸畸形、重建和维持脊柱稳定性。     

Cervical vertebral erosion due to tortuous vertebral artery

A case of cervical vertebral erosion due to tortuous vertebral artery is presented. This entity is rare and only 11 cases have been reported in the literature. The present case is the first to be demonstrated by magnetic resonance imaging. The importance of considering this vascular anomaly in the differential diagnosis of cervical spinal tumors is discussed.     

Diagnosis of vertebral fractures by vertebral fracture assessment.

Vertebral fractures are independent risk factors for both vertebral and peripheral fractures and only one-third of these fractures come to clinical attention. Vertebral fracture assessment (VFA) is a radiographic method using dual X-ray absorptiometry (DXA) to assess vertebral deformities during bone density measurement. We performed VFA of the spine from T4 to L5 on a Delphi W device (Hologic, Bedford, MA) in 136 postmenopausal patients (69+/-10 yr). These patients also had X-rays of the thoracic and lumbar spine. VFA was independently compared with X-rays by two rheumatologists, for the diagnosis of vertebral fractures at both the patient and vertebral levels. Using X-rays, 61 patients (45%) had at least one vertebral fracture. The percentage of unreadable vertebrae was 1% and 12.4% on X-rays and VFA, respectively (p<0.0001). At the patient level, VFA allowed to diagnose if the patient had no fracture or had at least one fracture in 74% of patients. In 11.2% of cases, VFA misclassified the patients. At the vertebral level, diagnostic efficacy of VFA as compared with X-rays was 97%. Concordance between both observers was good (kappa-score=0.69). We designed an algorithm for decision of performing X-rays in postmenopausal women: Using results of VFA would avoid X-rays in 32% of our patients. VFA is a reliable technique with low radiation, and is easily and rapidly applicable during bone density measurement by DXA, which could improve management of osteoporotic patients.     

Predicting human vertebral bone strength by vertebral static histomorphometry

The study investigates the relationship between static histomorphometry and bone strength of human lumbar vertebral bone. The ability of vertebral histomorphometry to predict vertebral bone strength was compared with that of vertebral densitometry, and also with histomorphometry and bone strength of iliac crest bone biopsies. The material comprised matched sets of second lumbar vertebrae, third lumbar vertebrae, and two iliac crest bone biopsies from each of 21 women (19--96 years) and 24 men (23--95 years). One of the iliac crest biopsies and 9-mm-thick mediolateral slices of half of each of the entire vertebral bodies (L-2) were used for histomorphometry. The other iliac crest biopsies and the L-3 were destructively tested by compression. High correlation was found between BV/TV or Tb.Sp and vertebral bone strength (absolute value of r = 0.86 in both cases). Addition of Tb.Th significantly improved the correlation between BV/TV and bone strength, and the addition of bone space star volume significantly improved the correlation between Tb.Sp and bone strength (from absolute value of r = 0.86 to absolute value of r = 0.89 in both cases). Bone structure (connectivity density) was not capable of improving the prediction of bone strength of the vertebral body. The correlations between BV/TV of L-2 and bone strength of L-3 were comparable with the correlation obtained by quantitative computed tomography (QCT), peripheral QCT (pQCT), and dual-energy X-ray absorptrometry (DEXA) of L-3 and bone strength of L-3. The iliac crest was found to have low predictive power of vertebral bone strength (iliac BV/TV: r = 0.62; iliac bone strength: r = 0.67). No gender-related differences were found in any of the relationships. It was shown that trabecular bone volume BV/TV and mean trabecular plate separation Tb.Sp are good predictors of vertebral bone strength. The ability of histomorphometry to predict vertebral bone strength was comparable to that of densitometry. Bone structure assessed by connectivity density did not improve the correlation between static histomorphometric measures and vertebral bone strength. No gender-related differences were found in any of the relationships. Neither static histomorphometry nor biomechanical testing of iliac crest bone biopsies is a good predictor of vertebral bone strength.     

Age-related changes in vertebral height ratios and vertebral fracture

Because no gold standard for the definition of vertebral fracture exists, there has been controversy about whether mild vertebral deformities are truly fractures or simply normal variation in vertebral size and shape. The aim of this study was to assess the associations of mild variations of vertebral height ratios to definite vertebral fractures. In 479 Japanese women (age 53.9±9.1 years) who visited our institute for a medical checkup, we performed lateral lumbar radiographs and morphometric parameters were derived by measuring the anterior (Ha), middle (Hm) and posterior (Hp) height of each vertebral body from T12 to L4. Vertebral height ratios, Ha/Hp, Hm/Hp or Hp/Hp of adjacent vertebrae that were more than 3 SD different from vertebra-specific means of normative data were considered to indicate fractures. Forty-five women were diagnosed with at least one fracture. After excluding the subjects with vertebral fracture, we examined the associations of the variations in vertebral height ratios with age, anthropometric parameters and lumbar bone mineral density (BMD) measured by dual-energy X-ray absorptiometry. Vertebral height ratios, especially Hm/Hp in postmenopausal women, tended to decrease with age and were positively associated with BMD. No significant correlation was observed between anthropometric parameters and vertebral height ratios. Age-related decrease in vertebral height ratios (Ha/Hp and Hm/Hp, each averaged from T12 to L4) was significant even after the correction for BMD. Mean values of height ratios of non-fractured vertebrae adjusted for age and BMD were significantly lower in postmenopausal women with vertebral fracture than in those without vertebral fracture. Logistic regression analysis showed that BMD and height ratios of non-fractured vertebrae were independent predictors of vertebral fracture risk. The results suggest that older women, and women with at least one obvious (3 SD) fracture, tend to have mild deformities which do not qualify using the 3 SD definition. These mild deformities may represent real consequences of osteoporosis, because they are more pronounced among women with obvious fracture.     

骨质疏松性椎体压缩骨折经皮椎体强化术后椎体高度再丢失的研究进展

正经皮椎体强化术包括经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP),两者通过微创手术治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF),可有效缓解疼痛、恢复压缩椎体高度和脊柱稳定性。但近年来观察到PVP和PKP术后恢复的椎体高度存在再丢失现象(没有创伤的情况下),术后椎体高度的再丢     

椎动脉三维CT血管成像对椎动脉型颈椎病的诊断价值

目的:探讨椎动脉三维CT血管成像(CTA)在椎动脉型颈椎病(CSA)诊断中的应用价值。方法:2007年7月～2008年4月临床上诊断为CSA的患者共21例(CSA组),对其CTA上显示的椎动脉、横突孔及钩椎关节增生情况进行观测,并与21例非CSA患者(对照组)的CTA观测结果进行比较分析。结果:CSA组中椎动脉正常者4例,管腔变细者7例,走行异常者1例,椎动脉硬化者2例,管腔局限性狭窄者4例,血管走行迂曲者3例,无血管闭塞的患者。对照组中14例椎动脉表现正常,管腔变细者4例,走行迂曲者3例。两组中血管正常、局限性狭窄出现比率间均有显著性差异(P0.05,χ2分别为9.72、1.21)。CSA组中11例(52.4%)患者共有36个钩椎关节增生,以C4～C7增生(28个,77.8%)最为常见,32个(88.9%)为轻度增生,3个(8.3%)为中度增生,1个(2.8%)为重度增生。对照组中,6例(28.6%)患者共有19个钩椎关节增生,只有1个(5.3%)表现为中度增生,其余均为轻度增生。结论:CTA可以较好地显示椎动脉异常、局限性狭窄及钩椎关节的增生情况,在CSA中具有一定的诊断价值。     

Multiple vertebral osteonecrosis

Vertebral osteonecrosis classically presents with an intravertebral vacuum cleft phenomenon or a fluid-filled cleft on MR images. These clefts are usually found in older patients presenting with more severe fractures, more significant collapse and instability. Therefore, although considered for a long time as pathognomonic for vertebral osteonecrosis, vertebral clefts are now considered to represent fracture non-union. The double-line sign is classically described for osteonecrosis of long bones, but has been reported in one case of concurrent spinal cord and vertebral bone marrow radionecrosis. We present a case of a histologically confirmed multilevel vertebral osteonecrosis manifesting as a double-line sign in the absence of an associated vertebral collapse and unrelated to radiotherapy.